Managing Ulnar Nerve Compression: Treatment Options and Recovery Tips

Symptoms of ulnar nerve compression?

I was diagnosed with left ulnar nerve neuropathy at National Taiwan University Hospital, and the onset has been about 4 months.
I have undergone Western medicine treatment for 3 months and Traditional Chinese Medicine treatment for 2 months.
The numbness in my hand has improved from an initial tingling sensation to about 80% of the time feeling numb (20% feeling 50% numb).
I am currently taking Vitamin B and C, along with Traditional Chinese Medicine (Shu Jing Huo Xue Decoction + Frankincense + Myrrh + Dipsacus + Duhuo + Chicken Blood Vine).
The strength in the affected area is about 70% of normal, and my finger strength is about 80-90%, with no muscle atrophy.
My occupation is a bus driver, and I drive for about 10 hours a day.
During this time, my hand injury has been fluctuating, which is very frustrating.

I would like to ask the doctor how to protect myself if I cannot stop driving the bus.
Is rehabilitation possible? Given that it has been 4-5 months, is there a chance for the hand nerve to fully recover if this continues? How can I ensure I am taking advantage of the best treatment window? The doctor at National Taiwan University suggested surgery, but also mentioned that there is no guarantee of returning to the original condition.
I would like to ask for your empathetic advice on how to proceed.
Is surgery the only option? Are there no alternatives? No one is without fear of surgical failure! Additionally, could you please provide information on the cost of surgery, the duration of hospitalization, when I can return to work after discharge, and any precautions I should take?

Zongming, 30~39 year old female. Ask Date: 2008/12/19

Dr. Lin Zijing reply Neurology

Ulnar nerve compression is most commonly caused by improper posture, such as resting the chin on the hands with the elbows supported on a table or chair armrest.
Leaning on the table while playing mahjong, using the elbow as a pillow during naps, or keeping the elbows tightly against the table while working or writing can also contribute.
Additionally, lying flat on the back with the elbows resting against a hard surface for extended periods can lead to compression.
Patients with a history of elbow dislocation or fracture may develop ulnar nerve palsy due to elbow joint contracture and deformity over time.

Beyond the elbow, prolonged use of crutches can compress the ulnar nerve in the axillary region.
Workers using power drills may also injure the ulnar nerve in the wrist or palm.
Therefore, it is advisable to avoid resting the elbows on the steering wheel while driving to prevent nerve compression.
It is important to keep the elbows elevated and avoid impacts, as well as not using the elbows to support the body.

If symptoms do not improve or worsen, an electromyography (EMG) test should be performed, as it helps assess prognosis and the need for surgery.
Generally, symptoms that are mild and recently occurred have a good prognosis, while recurrent symptoms with muscle atrophy indicate a poorer prognosis (less favorable recovery).
For surgical concerns, consultation with a neurosurgeon is recommended.

Reply Date: 2008/12/19

More Info

Managing ulnar nerve compression can be a challenging process, especially for someone like you who relies on hand function for your job as a bus driver. Ulnar nerve compression, often referred to as cubital tunnel syndrome when it occurs at the elbow, can lead to symptoms such as numbness, tingling, and weakness in the hand. Given your situation, let's explore treatment options, recovery tips, and considerations regarding surgery.

Treatment Options
1. Conservative Management: Since you have already undergone both Western and traditional Chinese medicine treatments, it is essential to continue with conservative management if you are experiencing some improvement. This includes:
- Physical Therapy: Engaging in a structured rehabilitation program can help improve strength and flexibility in your hand and wrist. A physical therapist can provide exercises tailored to your specific needs and monitor your progress.

- Activity Modification: As a bus driver, you may need to adjust how you use your hands during work. Consider using ergonomic tools or supports that can help reduce strain on your hands. Taking regular breaks to stretch and rest your hands can also be beneficial.

- Splinting: Wearing a splint, especially at night, can help keep your elbow straight and reduce pressure on the ulnar nerve.

2. Medications: You mentioned taking vitamin B and C, which can support nerve health. Additionally, over-the-counter anti-inflammatory medications may help reduce any swelling or discomfort.

3. Alternative Therapies: Acupuncture or other forms of traditional Chinese medicine may provide relief for some individuals. If you find these treatments beneficial, continue them as part of your comprehensive approach.

Surgical Options
If conservative treatments do not yield satisfactory results, surgery may be considered. The decision to proceed with surgery should be based on several factors:
- Severity of Symptoms: If your symptoms are significantly impacting your daily life and job performance, surgery may be warranted.

- Duration of Symptoms: Since you have been experiencing symptoms for about four months, it is crucial to weigh the potential benefits of surgery against the risks. Generally, the sooner you address nerve compression, the better the chances of recovery.

Surgical Considerations
1. Surgical Procedure: Ulnar nerve decompression surgery involves relieving pressure on the nerve, which may include moving the nerve to a different position or removing any structures compressing it.

2. Recovery Time: Post-surgery, recovery can vary. Typically, patients may stay in the hospital for a day or two, and full recovery can take several weeks to months. You may need to avoid heavy lifting or repetitive hand movements during this time.

3. Return to Work: Depending on the nature of your job and the extent of the surgery, you may be able to return to work within a few weeks. However, it is essential to follow your surgeon's advice regarding when to resume driving and other activities.

Managing Expectations
It is understandable to have concerns about surgery and its outcomes. While surgery can significantly improve symptoms for many, it is essential to have realistic expectations. Discuss with your surgeon the likelihood of returning to your previous level of function and any potential risks involved.

Conclusion
In summary, while surgery is a viable option for ulnar nerve compression, it is not the only choice. Continuing with conservative treatments, engaging in physical therapy, and making ergonomic adjustments at work can all contribute to your recovery. If you decide to pursue surgery, ensure you have a thorough discussion with your healthcare provider about the procedure, recovery, and what to expect. Remember, every case is unique, and your healthcare team is best equipped to guide you through this process.

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